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Surgeon General Sees 4-Year Term as Compromised

Former Surgeons General C. Everett Koop, left, Richard H. Carmona and David Satcher testified on Tuesday before the House Oversight and Government Reform Committee. All said they had felt political pressure.Credit
Kevin Dietsch/United Press International

WASHINGTON, July 10 — Former Surgeon General Richard H. Carmona told a Congressional panel Tuesday that top Bush administration officials repeatedly tried to weaken or suppress important public health reports because of political considerations.

The administration, Dr. Carmona said, would not allow him to speak or issue reports about stem cells, emergency contraception, sex education, or prison, mental and global health issues. Top officials delayed for years and tried to “water down” a landmark report on secondhand smoke, he said. Released last year, the report concluded that even brief exposure to cigarette smoke could cause immediate harm.

Dr. Carmona said he was ordered to mention President Bush three times on every page of his speeches. He also said he was asked to make speeches to support Republican political candidates and to attend political briefings.

And administration officials even discouraged him from attending the Special Olympics because, he said, of that charitable organization’s longtime ties to a “prominent family” that he refused to name.

The Special Olympics is one of the nation’s premier charitable organizations to benefit disabled people, and the Kennedys have long been deeply involved in it.

When asked after the hearing if that “prominent family” was the Kennedys, Dr. Carmona responded, “You said it. I didn’t.”

In response to lawmakers’ questions, Dr. Carmona refused to name specific people in the administration who had instructed him to put political considerations over scientific ones. He said, however, that they included assistant secretaries of health and human services as well as top political appointees outside the department of health.

Dr. Carmona did offer to provide the names to the committee in a private meeting.

Bill Hall, a spokesman for the Department of Health and Human Services, said that the administration disagreed with Dr. Carmona’s statements. “It has always been this administration’s position that public health policy should be rooted in sound science,” Mr. Hall said.

Emily Lawrimore, a White House spokeswoman, said the surgeon general “is the leading voice for the health of all Americans.”

“It’s disappointing to us,” Ms. Lawrimore said, “if he failed to use this position to the fullest extent in advocating for policies he thought were in the best interests of the nation.”

Dr. Carmona is one of a growing list of present and former administration officials to charge that politics often trumped science within what had previously been largely nonpartisan government health and scientific agencies.

Dr. Carmona, 57, served as surgeon general for one four-year term, from 2002 to 2006, but was not asked to serve a second. Before being nominated, he was in the Army Special Forces, earned two purple hearts in the Vietnam War and was a trauma surgeon and leader of the Pima County, Ariz., SWAT team. He received a bachelor’s degree, in biology and chemistry, in 1976 and his M.D. in 1979, both from the University of California, San Francisco. He is now vice chairman of Canyon Ranch, a resort and residential development company.

His testimony comes two days before the Senate confirmation hearings of his designated successor, Dr. James W. Holsinger Jr. Two members of the Senate health committee have already declared their opposition to Dr. Holsinger’s nomination because of a 1991 report he wrote that concluded that homosexual sex was unnatural and unhealthy. Dr. Carmona’s testimony may further complicate Dr. Holsinger’s nomination.

In his testimony, Dr. Carmona said that at first he was so politically naïve that he had little idea how inappropriate the administration’s actions were. He eventually consulted six previous surgeons general, Republican and Democratic, and all agreed, he said, that he faced more political interference than they had.

On issue after issue, Dr. Carmona said, the administration made decisions about important public health issues based solely on political considerations, not scientific ones.

“I was told to stay away from those because we’ve already decided which way we want to go,” Dr. Carmona said.

Photo

Richard H. Carmona

He described attending a meeting of top officials in which the subject of global warming was discussed. The officials concluded that global warming was a liberal cause and dismissed it, he said.

“And I said to myself, ‘I realize why I’ve been invited. They want me to discuss the science because they obviously don’t understand the science,’ ” he said. “I was never invited back.”

Dr. Carmona testified under oath at a hearing before the House Oversight and Government Reform Committee headed by Representative Henry A. Waxman, Democrat of California. The topic was strengthening the office of the surgeon general. Dr. C. Everett Koop, surgeon general in the Reagan administration, and Dr. David Satcher, surgeon general during the Clinton administration and the first year of the administration of George W. Bush, also testified.

Each complained about political interference and the declining status of the office. Dr. Satcher said that the Clinton administration discouraged him from issuing a report showing that needle-exchange programs were effective in reducing disease. He released the report anyway.

Dr. Koop, said he had been discouraged by top officials in the Reagan administration from discussing the AIDS crisis. He did so anyway.

All three men urged major changes in the way the surgeon general is chosen and the way the office is financed.

Dr. Carmona described being invited to testify at the government’s nine-month racketeering trial of the tobacco industry that ended in 2005. He said top administration officials discouraged him from testifying while simultaneously telling the lead government lawyer in the case that he was not competent to testify. Dr. Carmona testified anyway.

Sharon Y. Eubanks, director of the Justice Department’s tobacco litigation team, was in the audience during Dr. Carmona’s testimony.

“What he said is all correct,” she said. “He was one of the most powerful witnesses. His testimony was very important.”

Dr. Carmona said that he felt that the duty of the surgeon general, often called the “nation’s doctor,” was to tackle many of the nation’s most controversial health topics and to issue balanced reports about the studies underlying them.

When stem cells became a focus of debate, Dr. Carmona said he proposed that his office offer guidance “so that we can have, if you will, informed consent.”

“I was told to stand down and not speak about it,” he said. “It was removed from my speeches.”

The Bush administration rejected the advice of many top scientists on this subject, including that of the director of the National Institutes of Health, Dr. Elias Zerhouni.

Similarly, Dr. Carmona wanted to address the controversial topic of sexual education, he said. Scientific studies suggest that the most effective approach includes a discussion of contraceptives.

“However there was already a policy in place that did not want to hear the science but wanted to preach abstinence only, but I felt that was scientifically incorrect,” he said.

Dr. Carmona said drafts of surgeon general reports on global health and prison health were still being debated by the administration. The global health report was never approved, Dr. Carmona said, because he refused to sprinkle the report with glowing references to the efforts of the Bush administration.

“The correctional health care report is pointing out the inadequacies of health care within our correctional health care system,” he said. “It would force the government on a course of action to improve that.”

Because the administration does not want to spend more money on prisoners’ health care, the report has been delayed, Dr. Carmona said.

“For us, the science was pretty easy,” he said. “These people go back into the community and take diseases with them.” He added, “This is not about the crime. It’s about protecting the public.”

A version of this article appears in print on , on Page A1 of the New York edition with the headline: Surgeon General sees 4-year term as compromised. Order Reprints|Today's Paper|Subscribe